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Crohn's Disease
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Posted 2/9/2011 8:06 PM (GMT 0)
Hi all,

I haven't stopped by in awhile (which means I've been healthy) - I hope you're doing well.

In Dec. I did my routine bloodwork & my liver enzymes were high so I did a redraw last week & they were still high. As of Monday, my GI had me stop all azathioprine & cut down to 1 Lialda/day. I'll stay off for 2 weeks then redraw the blood (I also have my annual colonoscopy scheduled 2/19).

Because my dr. called while I was at my desk at work, I didn't ask very many questions. Have your levels been high before where you've had to stop meds? I've been on 150mg of azathioprine for 6+ years without decreasing the dose so I'm nervous. Any insight/information to share?

tia.

Posted 2/9/2011 8:56 PM (GMT 0)
You have to click add signature when you start a new post.

Unfortunately I don't have an answer for you. Hopefully someone else will be along soon with one for you. Hugs!
Posted 2/9/2011 9:07 PM (GMT 0)
Thanks, Nanners. I missed that check box.
Posted 2/10/2011 12:14 AM (GMT 0)
How high were your liver enzymes?

If I were your doctor, I would have had your stop the Lialda, since it's of questionable benefit anyway, and then I would have you do the Prometheus Labs test where they check your thiopurine metabolite levels and see whether your dose is higher than therapeutically necessary. If it were, then perhaps all you'd need to do is lower your azathioprine dosage from 150mg to, say, 100 mg or 125 mg.
Posted 2/10/2011 1:39 AM (GMT 0)
When my liver enzymes were consistently high, I had to have a liver biopsy but my meds weren't reduced. I think this is a very conservative approach, considering.
Posted 2/10/2011 1:23 PM (GMT 0)
I've had to stop at least a half dozen meds due to elevated liver enzymes.  They got so bad at one point that I had a liver biopsy, ERCP and MRCP and they just showed inflammed bile ducts but nothing else.  The enzymes always go back to normal once I stop whatever meds were causing it, although sometimes it takes a month for them to go back down.
Posted 2/10/2011 4:18 PM (GMT 0)

beave said...
How high were your liver enzymes?  I'm not sure, like I said, I didn't ask enough questions, but I will after the next round of labs.

If I were your doctor, I would have had your stop the Lialda, since it's of questionable benefit anyway, and then I would have you do the Prometheus Labs test where they check your thiopurine metabolite levels and see whether your dose is higher than therapeutically necessary. If it were, then perhaps all you'd need to do is lower your azathioprine dosage from 150mg to, say, 100 mg or 125 mg.

I've done the Prometheus Labs several times but not recently.

Posted 2/10/2011 5:53 PM (GMT 0)
In general, docs are quick to respond to elevated liver enzymes because you can have extensive liver damage before you get significant lab results.

This isn't to say that this is true in your case. Just an explanation of why a lot of docs will respond quickly or conservatively in this situation.

The other thing to know about the liver is that it can heal itself/recover much more than a lot of our other organs if it is not stressed. So it may be that the doc will want to reintroduce the AZA after your levels have normalized to see if your liver can once again handle that med.

An alternative is to pair Imuran with Allopurinol. Allopurinol reduces the stress that AZA puts on the liver while still allowing you to get the full therapeutic benefit of the AZA.

And it can take 2 weeks to get a Prometheus result back so it is safer to withdraw the suspect meds promptly. Given the length of time you've been on AZA, I'm guessing that also contributed to the docs decision.

Your plan to talk it over with the doc in more detail is a good one. We are all just guessing and the doc is really the one who can answer your questions.

Best wishes,

Patricia
Posted 2/10/2011 8:32 PM (GMT 0)
Sugarfoot I would like to refute something that Beave said. While the 5asa meds may not work for some, they do for others. I have been successfully treated with some form of 5asa med my whole time with Crohns (almost 36 yrs). Did a brief stint with 6mp, but other than that its always been one form of 5 asa med or another. Just fyi Lialda is a 5asa med.

Hugs~
Posted 2/10/2011 10:23 PM (GMT 0)
I agree, Nanners. I was on Asacol for ~5 years before I switched to Lialda.
Posted 2/10/2011 10:24 PM (GMT 0)
Thank you for your responses, everyone.
Posted 2/10/2011 11:24 PM (GMT 0)
I clearly stated it was of "questionable benefit." I did not say it flat out does not work for anybody.

I stand by that statement, and the studies back me up.
Posted 2/11/2011 1:32 AM (GMT 0)
Hi.  I'm new here.  Just diagnosed with Crohn's in November.  My doc put me on azathioprine a month ago on a really low dose as apparently I don't exhibit the level of enzymes he likes to see when perscribing this med.  On monday I had my follow up and my liver levels were through the roof and I was told to stop taking the meds.  (I'm still on prednisone to control the inflammation).  He discussed flipping to another chemical med, but because of my body's reaction doesn't think it will take.  He recommended starting Remicade to control the Crohn's...has anyone been recommended to go this route because of liver levels? 

Posted 2/11/2011 2:07 AM (GMT 0)
I am taking allopurinol with my 6mp because I always had problems with liver enzymes. I am happy to report that since adding allopurinol 100mg, I am doing 100x better. The level of 6mp went way up and the level of toxicity went way down. I definitely recommend talking to your GI about this combo before stopping a drug if it was helping you stay in remission. I am so thankful that my GI came up with this solution for me, I felt like I was running out of options.
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